Traumatic aortic rupture (TAR) leads to immediate death in 75 to 90% of cases. Conventional surgery for TAR still carries high risk of serious complications and mortality. Thoracic endovascular aortic repair (TEVAR) has emerged as a valid alternative compared with open surgery
From March 2001 to March 2018, out of 289 patients undergone TEVAR, 26 patients (9.0%) were treated for a TAR after road accident. To assess the risk it was evaluated the Injury Severity Score (ISS) in patients with multiple injuries and the American Society of Anesthesiologist classification (ASA class) to describe the perioperative physical status. 15 patients (57.7%) showed an unstable clinical picture (ISS ≥ 40). Four patients (15.4 %) had a delayed TEVAR, the remaining 22 (84.6 %) required an urgent or emergency treatment within 12 and 48 hours.
There were no operative death or surgical conversion. Any neurological complication, including paraplegia, was observed. One patients died after 48 hours for intracranial associated lesions. One vascular complication occurred requiring a rescue prosthetic ileofemoral bypass. Eleven patients (42.3%) required prolonged mechanical ventilation and two (7.7%) undergone CRRT. At follow-up (6–204 months), only one patient showed a late Type I endoleak, requiring a secondary TEVAR.
TEVAR is a safe procedure in TAR patients, especially in unstable/emergent conditions. Moreover, TEVAR allows for prompt treatment of associated lesions in complex multitrauma patients. Most frequently the associated lesions especially of intracranial or intraabdominal organs became prognostically predictive of postoperative outcome.
1Department of Cardiac Surgery, School of Medicine, University of Naples “Federico II” Napoli
2Department of Anesthesiology, School of Medicine, University of Naples “Federico II” Napoli